I. Fundamentals of Embalming
A. Background information
1. Brief summary of the process of embalming
2. Definition of embalming
a. Etymology: em in or about, and balm resinous substance,
balsamic agents
d. Sanitation, preservation, and restoration
1. Sanitation and disinfection
a. Change of body proteins
b. Destruction of most autolytic and bacterial enzymes
1. Ancient Egyptian embalming
2. Ancient Greek embalming
3. Ancient Roman embalming
4. Early Hebrew embalming
D. Professional and ethical conduct
(1). To show respect for the dead
(2). To maintain the standards of the profession by practicing
high moral standards
(1). Keep preparation room strictly private
(a). Embalmer, funeral director and authorized employees
(b). Those authorized by the family
(c). Those authorized by law (reference state law)
(2). Maintain proper identification and security of preparation
room
(3). Instruct and maintain highest moral standards
(a). Keep body covered at all times-cotton, paper towels, rubber
pants, coveralls
(b). Take no liberties whatsoever
(c). Guard loose talk and remarks
(d). Repeat nothing outside of preparation room
(e). Disclose no confidential facts as to conditions, age,
deformities, or diseases causing death
a. Authorization to embalm
b. Authorization for procedure other than embalming
(2). Organ, tissue donation
c. Identification procedures
(1). Deceased and personal effects
(2). Blood sample, fingerprints, and photos with proper
authorization
d. Responsibility to report certain observations to the medical
examiner/coroner or the police
E. Sanitation: personal and environmental hygiene
1. Unsanitary condition of dead body and immediate environment
b. To protect the operator
c. To create a clean, sanitary body
a. To protect the operator
(1). Wear rubber gloves (possible double gloving)
(2). Wear special clothing in preparation room
b. Following completion of embalming, employ maximum personal
hygienic standards
(3). Wash thoroughly (e.g., shower)
(4). Oral and nasal cavities
a. To create a clean, sanitary body
(1). Thorough bathing and external disinfection of body
(2). Disinfection of all external orifices of the body
(3). The use of good disinfecting embalming chemicals
(1). Proper disposition of infected clothing
(b). Destroy after proper authorization
(2). Disposal of all waste materials from the embalming procedure
(3). Strict compliance with all rules and regulations of the
State Board of Health
(a). Primary disinfection prior to the embalming process
(b). Concurrent disinfection during the embalming process
(c). Terminal disinfection following the embalming process to
protect environment
1. Instruments and equipment
F. OSHA Hazard Communication Standard
2. Employee exposure monitoring
a. Controls to reduce exposure levels
(1). Material Safety Data Sheet (MSDA)
f. Employee information and training
II. Death
B. Terminology associated with death
1. Moribund (agonal period)
c. Instantaneous rigor mortis (cadaveric spasm)
b. Cremains/cremated remains
b. Biological (irreversible)
c. Modes (according to Bichat)
(1). Follows somatic death
(2). Factors influencing onset of postmortem cellular death
(c). Environmental conditions
(d). Medication preceding death
2. Cessation of circulation
3. Cessation of respiration
4. Complete muscular relaxation
6. Rigor mortis: instantaneous rigor
7. Livores mortis, cadaveric lividity
b. Loss of luster of conjunctiva
d. Pupil dilation, no response to light
c. Injections of various dyes into the body to test for
circulation
d. Electronic life detection devices (e.g., encephalogram)
b. Ammonia injection test
c. Feel for pulse at the radial artery
d. Place the ear over the thoracic cavity
III. Pre-Embalming Changes
A. Antemortem (agonal changes)
b. Congealing (coagulation)
4. Bacterial migration from intestinal areas to blood vascular
system due to capillary permeability changes
(2). Conditions governing the rate
(b). Amount of clothing covering the body
(d). Cause and manner of death
(e). Environmental temperature and humidity
(2). Imbition (Postmortem edema)
(3). Gravitation of serum
e. Increase in viscosity of blood
(3). Agglutination of formed elements
(1). Types of decomposition
(1). Self-destruction of cells
(1). Bacterial decomposition of carbohydrates under aerobic
conditions
(2). Signs of decomposition
(e). Accumulation of gas in viscera, cavities and other body
tissues
(3). Product of decomposition
(c). Ptomaines: Skatole, indole, cadaverine and putrescine
(d). End products: ammonia, ammonium compounds, hydrogen,
hydrogen sulfide, mercaptan, nitrogen, carbon dioxide,
water, methane, phosphoric acid, and sulfuric acid
(4). Factors governing decomposition
(4). Cause and manner of death
(5). Pressure due to earth or clothing
(5). Order of decomposition of the body compounds
(6). Order of putrefaction of the organs (viscera)
b. Change in the pH of the body
(3). During advanced decomposition
(2). Conditions affecting onset, duration, and termination
(e). Condition of muscles
(3). Order of appearance and disappearance
(4). Physical methods of reducing rigor mortis
IV. Embalming Equipment, Instruments, and Materials
10. Sterilizers (e.g. chemical, heat/pressure)
11. Position devices: head rests, arm rests, shoulder rests,
foot rests
9. Hemostats (lock forceps)
23. Trocar button applicator
3. Disinfectant chemicals
4. Sealers (e.g., external and internal
V. Preparation of the Body
3. Variable factors encountered among dead bodies
(1). Cause and manner of death
(a). Pathological conditions
(d). Thermal influences (fever)
(e). Nitrogenous waste products
(3). Presence or absence of discolorations
(5). Medications and drugs present at death
(a). Atmospheric conditions
(c). Bacterial influences
B. Initial treatment of the body
1. Disinfection of the oral and nasal cavity
2. Remove and record all clothing and personal effects
3. Disinfection of clothing when necessary
4. Remove medical dressings and devices and disinfect
a. Materials and proper procedure
b. Cleaning and disinfecting agents
1. Body should be placed on a table with the head elevated
above the rest of the body
2. The face may be tilted to the right, about 15 degrees, which
is the generally preferred casketing position
3. Be sure the body is straight on the table
4. Hands should be placed in a desirable position
5. The head should be placed on the head rest in such a way
that it will not interfere with distribution of fluid
drainage
6. The use of additional posing devices may be necessary in
special cases t to hold the body in proper position on the
table
2. Prepare the face with cream or oil
c. Base for further massage
(1). Excessive manipulation of the lip tissue can cause
distention
(2). Sharp teeth can cause personal injury
(1). Relieve rigor mortis
(2). Disinfect and cleanse oral and nasal cavities
(3). Remove, cleanse, and disinfect dentures
(5). Observe points of natural expression
(a). Five arcs in the line of lip closure
(b). Protrusion of the upper lip
(c). Natural facial lines
(d). Corners of the mouth slightly raised
(f). Hypo-injection masseter muscle
c. If the lips will not stay closed
(1). Use wet cotton strips
(2). In extreme cases, particularly in cases of a dehydrated lip,
suture with a hidden stitch
(3). Use creams to assist lip closure
(5). In extreme cases of dental prognathism (buck teeth), after
obtaining permission in writing from the family
(d). Make an incision posterior and transverse in the low lip,
then stretch the lips to the desired length. The placement
of wax in the incision will prevent the formation of lines
of demarcation
(1). Do not manipulate the eyelids any more than necessary
(2). Swab out with a suitable non-astringent disinfectant
(3). Cream may be used; putting small amounts under the lid will
effect better closure and protect against dehydration
(4). Location of line of closure is in the inferior one-third of
the eyesocket
(5). Eyelids should abut and not overlap
b. Special considerations
(1). In cases where eyes are sunken into the eyesocket
(2). In cases where fluid is lost from the eye (cupped eyeball)
(3). Types of eyecaps and methods of application
(5). Eye enucleation restoration
VI. Selection of Arteries
A. Considerations and precautions of each artery
b. Surrounding structures
4. Effect on posing the body
5. Location regarding the exposed areas
6. Practicability of draining from corresponding veins
1. Arteries of head and neck
(a). Right common carotid
(a). Direct distribution to the face
(b). Close to center of venous drainage
(c). Close to center of circulation
(d). Face possibly can be embalmed with a mild solution, while
remaining portion of body can be injected with a more
preservative solution
(e). Has no branches except its terminal branches
(a). Incision may be visible after dressing
(b). Tubes may leave mark on face
(c). Face may be over-injected
(7). Accompanying vein: internal jugular
2. Arteries of upper extremity
(b). Close to center of circulation
(c). Close to center of venous drainage
(d). Vessels are relatively superficial
(a). Danger of over-injecting face
(b). Anomalies of both artery and vein are common
(c). If the arm is not treated properly, it does not appear
natural when body is placed in the casket
(7). Accompanying vein: axillary vein
(7). Accompanying vein for drainage: Basilic vein
a. Subclavian artery (autopsied bodies)
b. Brachiocephalic artery
(a). Descending thoracic aorta
(4). Accompanying vein for drainage: Superior and inferior vena
cava
(2). Accompanying vein: Common iliac vein
(2). Accompanying vein: External iliac vein
f. Internal iliac artery and internal iliac vein
4. Arteries of lower extremity
(b). Lower portion of body can be embalmed without concern of
distention of face
(c). Even fluid distribution to both sides of the face
(d). Arms can be placed in natural position
(a). Vessels are deep-seated in obese cases
(b). Drainage is sometimes difficult to establish and maintain
(7). Accompanying vein: Femoral vein
c. Anterior tibial artery
d. Posterior tibial artery
D. Factors governing selection of artery to be injected
3. Weight (fat distribution)
4. Disfigurations (arthritis, etc.)
6. Local obstruction (congestion)
7. Mutilation (accident or surgery)
8. Medical/legal requirements (autopsy rules)
9. Cause of death (cancer, etc.)
E. Proper technique for raising vessels
1. Shave area, if necessary
2. Select instruments and prepare ligature
3. Make proper incision through skin, superficial fascia and
deep fascia
4. Find vessels by use of anatomical guide and relative
position of vein
5. Clean off by blunt dissection and ligate vein loosely
6. Clean off and ligate artery loosely
7. Make incision in vessels
F. Types of sutures for closing incisions
3. Single intradermal (subcutaneous)
4. Double intradermal (subcutaneous)
G. Other methods of closing incisions
VII. Injection
1. One point injection: injection and drainage from one
location
2. Split injection: injection and drainage from separate places
3. Multi-point or sectional injection: two or more complete
injection sites
4. Restricted cervical: raising of both common carotids
(1). Approximately 1/2 (.43) 1b. pressure per foot from height of
the column of liquid to the point of injection
(2). One 1b. pressure for each 28 inches of height from column of
liquid to the point of injection
(2). Low cost of equipment
(3). Requires no mechanical apparatus
(1). Limited pressure range
(2). Inconvenient refilling
(3). Small unit volume (usually)
(2). Adaptable to aspiration
(3). Sensitive to internal vascular pressures (increased
resistance detected by thumb)
(b). Requires use of one hand
(2). Irregularity of pressure with unknown maximum without
pressure gauge
(a). To operator (explosion)
(b). To success of operation (may cause distention)
(1). Variable pressure with unknown maximum
(2). Requires constant use of one hand
(3). Rubber deteriorates rapidly
4. Combination gravity and bulb syringe
(3). Compressed gas, CO2 or air
(3). Maintain constant pressure
(2). Small unit injection volume (usually)
(3). Requires frequent servicing
6. Motorized force pump (centrifugal)
(2). No suborddinate equipment necessary
(1). Needs frequent servicing
(2). Requires constant attention of operator
(1). Intravascular influence
(a). Condition of vessels
(2). Extravascular influences
(b). Generalized decomposition
(5). Type of apparatus used
VIII. Types of Embalming Chemicals
A. Arterial (preservative fluids)
(2). Strong, medium and weak
g. Perfuming materials, masking agents
(3). Water conditioners (water softeners)
5. Effects on body tissues and tissue fluid and proteins
a. Preservatives and fixatives
3. Humectant or restorative fluids
D. Special arterial fluids
(4). Counter staining compounds
(1). Hardening agent: plaster of Paris
2. Mold preventive agents
5. Pack applications (liquids and gels)
(1). Coagulating agents (tanning agents)
(3). Vehicles (organic solvents)
F. Safety in handling embalming chemicals: OSHA Hazard
Communications Standard-Section IF
IX. Dilution, Distribution, and Diffusion of Embalming Fluid
2. Determination of dilution needed by case analysis
3. Determination of right amount of fluid by formula
E. Signs of fluid distribution and diffusion
1. Distention of superficial vessels
2. Large volume of blood drainage
3. Reduction of intravascular blood discolorations
4. Loss of elasticity of tissue (beginning firming)
6. Tissue distention (lips, fingertips, etc.)
7. Mottling of tissue (bleaching)
F. Summary of all factors relative to fluid and its injection
1. Amount of fluid to use
3. Temperature of injection
6. Relation of each of the above to disinfection, preservation,
removal of discolorations, swelling, etc.
X. Drainage
A. Purpose and importance
1. Diminish secondary dilution
2. Remove intravascular discolorations
5. Retard post-embalming decomposition
C. Methods of drainage in relation to injection
D. Methods of stimulating drainage
E. Difficult drainage problems
XI. Cavity Treatment
A. General considerations
b. Upper row: right hypochondriac, epigastric, left
hypochondriac
c. Middle row: right lateral, umbilical, left lateral
d. Lower row: right inguinal, public, left inguinal
D. Aspiration and injection equipment and methods
c. Hand pump, or electric pump, bottle, gooseneck
2. For abdominal, pelvic and thoracic cavities
b. Direct incision method
c. Removal or purge material in throat
a. Conditions necessitating treatment
4. For reduction of distended neck
a. Conditions necessitating treatment
2. Advanced decomposition
5. Infectious diseases of abdominal organs and tissues
7. Abdominal distention or purge after embalming
E. Materials to be aspirated
2. Predisposing conditions
b. Pathological conditions
d. Environmental conditions
3. Types and characteristics of purge
XII. Autopsies, Necropsies or Postmortem Examinations
2. Thoracic and/or abdominal autopsy
B. Exploratory: removal of bone and soft tissue
XIII. Postmortem Conditions and Their Embalming Treatments
2. Classification according to occurrence
3. Classification according to cause
(1). Intravascular blood discolorations
1. Hypotasis (bluish-black)
2. Carbon monoxide (cherry red)
3. Capillary congestion (hypostatic, active passive)
(2). Extravascular blood discolorations
1. Ecchymosis (extravasation under the skin)
2. Petechia (pinpoint bleeding)
3. Hematoma (blood-filled swelling)
(b). Postmortem (hemoglobin decomposition)
(3). General treatment of discolorations (blood)
b. Drugs and therapeutic agents
(1). Antemorten discolorations resulting from the administration
of drugs or chemotherapeutic agents
(1). Antemortem discolorations which occur during the course of
certain diseases
(c). Bronzing: Addison's disease
d. Surface discoloring agents
(1). Antemortem or postmortem discolorations which occur prior to
(or during) embalming due to the deposit of matter on body
surface
(4). Importance of pre-embalming removal
e. Reaction of embalming chemicals upon body contents
(1). Razor burns or desiccaton marks
(3). The green which develops in a body which had jaundice or
similar pigmentary discolorations before embalming a yellow
discoloration of the sclera indicates a jaundiced condition
f. Decomposition indicates a jaundiced condition
(1). Postmortem discoloration due to action of bacterial and/or
autolytic enzymes on body tissues
(2). Progressive color changes in tissues if enzymes not
inhibited
(a). General treatment of discolorations (blood)
4. Conditions related to discolorations
(a). Skin unbroken but discolored treatment
(b). Skin scaling, as in exanthematous diseases treatment
(c). Skin broken, separated from the body abrasions, blisters
(vesicles), skin slip
(d). Pustular or ulcerative lesions
(7). Carbon monoxide poisoning
(9). Exsanguination (10) Electrocution
1. Conditions predisposing
z. Advanced decomposition
a. Intravascular difficulties
(1). Strength, type and quantity of chemicals
(a). Primary injection (pre-injection anticoagulant, etc.)
(b). Arterial and venous injection
(c). Large quantity, usual dilution
(d). Supplemental chemicals
(2). Mechanical and manual aids
(a). Low pressure, slow rate of flow
(b). Utilize care in raising vessels
(c). Use gauze or similar heavy material to tie off vessels to
prevent cutting or damage
(d). Use of various distribution and drainage aids elevation of
appendages, massage, etc.
(e). Proper selection of size and type of injection and drainage
instruments (tubes, forceps, etc. )
(3). Controlled injection and drainage
(a). Use of alternate injection and drainage or intermittent
drainage as indicated
(c). Arterial and venous injection may be necessary
(4). Sectional arterial injection
b. Extravascular difficulties
(1). Sectional hypodermic injection (used as supplement to
arterial embalming)
(2). Sectional arterial injection
(3). Operative aides (written permission should be obtained
(a). Necrotic tissue excision
(b). Swollen tissue excision
(4). Surface compresses in case of skin slip, etc.
1. Conditions predisposing to decomposition
2. Treatment for cases predisposing to early decomposition
a. Strength, type and quantity of chemicals
(1). Large volume arterial chemical
(2). Supplemental chemicals
(3). Medium solution strength
b. Mechanical and manual aids
(1). Normal pressure, normal flow
(2). Use of various distribution and drainage aids
c. Controlled injection and drainage
(1). Use of constant flow and intermittent drainage
(2). Arterial and venous injection, if necessary
d. Sectional arterial injection
e. Sectional hypodermic injection
3. Treatment of bodies where decomposition is present
a. Strength, type, and quantity of chemicals
(1). Astringent chemicals (high index)
(2). Large volume of well-coordinated solution
(4). Hot water recommended for fluid dilution
b. Mechanical and manual aids
(1). Use of various distribution and drainage aids
(3). Irrigate the nose and throat
(4). Tissue trocar or hypodermic needle
c. Sectional arterial embalming
d. Sectional hypodermic injection
(1). Excise swollen areas when available
(2). Plaster of Paris bandages
(3). Manufactured rubber garments
(4). Reducing and bleaching agents
(5). Disinfecting chemicals
1. Conditions predisposing to dehydration
a. Strength, type, and quantity of chemicals
(4). Coordinating chemicals
(5). Moisture retaining chemical
(6). Cold water for fluid diluting
b. Mechanical and manual aids
(1). Liberal application of massage cream
(3). Use of various distribution and drainage aids
(4). Hypodermic tissue fillers
(5). Controlled injection pressure and rate of flow
c. Controlled injection and drainage
(1). Constant flow and intermittent drainage
(2). Alternate injection and drainage
E. Body fluid accumulation
2. Conditions associated with edema
e. Lymph vessel obstruction (cancer, parasites)
f. Carbon monoxide poisoning
3. Fluid accumulation according to location
a. Anasarca: generalized edema of tissues
b. Ascites: in abdominal or peritoneal cavity
c. Hydrothorax: in pleural cavity
d. Hydrocephalus: intracranial
e. Hydropericardium: in pericardial cavity
4. Embalming complications
b. Secondary dilution of fluid
c. Possible skin slip (desquamation)
d. Distortion of body contour
(1). Elevation of extremities
b. Type, strength, and quantity of fluid
c. Possible sectional embalming by direct hypodermic injection
1. Postmortem evacuation of any substance from any external
orifice of the body
a. Purge prior to embalming
b. Purge during embalming
c. Purge following arterial and cavity embalming
(1). Direct treatment through an abdominal incision
(2). Nasal tube aspiration and irrigation of the throat
(3). Aspiration and injection of brain through the cribiform
plate when distended eyes indicate intracranial
decomposition
G. Deformities and malformations
1. Conditions causing deformities and malformations
a. Mechanical and manual aids to correct deformities
b. Operative aids to correct deformities
c. Sectional arterial embalming
d. Strength, type, and quantity of fluids
H. Contagion and infection
a. General considerations
b. Removal from place of death
c. Precautionary measures against contagion prior to, during,
and after embalming procedure
2. Contagious or infectious diseases
3. Possible postmortem findings
a. Low moisture content due to unusually high fever
b. Clotted condition of blood due to toxins and bacteria in
blood and presence of fever
4. Possible embalming treatments
1. General considerations
3. Personal hygiene for the embalmer
4. Substances used in diagnosis and treatment
J. Preparation of the infant case
1. Special considerations for the non-viewable case
a. Positioning of the infant
b. Methods of preservation
c. Appearance of the finished case
2. Pre-embalming considerations
3. Embalming considerations
a. Stillborn infants and those who die soon after birth
b. Babies up to one year of age
c. Children from one to five years of age
4. Post-embalming considerations
a. Closing and sealing of incisions
b. Cleaning and disinfecting procedures
K. Treatment of the case to be shipped
1. Pre-embalming analysis
2. Embalming considerations
c. Embalming solution strength and volume
3. Post-embalming preparation
a. Incision closing and sealing
b. Treatment of all orifices
c. Terminal disinfection of the body
d. Leakage precautions (plastic protectors, coveralls, etc.)
e. Stabilizing techniques in the casket or shipping case
f. Embalming documentation
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